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Aishwarya's CARE Call
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Coming to Fiona Stanley Hospital
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Visiting our hospitals
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Finding your way
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Maps
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Facilities
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Parking and transport
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Coming to Fremantle Hospital
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Visiting our hospitals
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Map of Fremantle Hospital
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Facilities
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Parking and transport
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Coming to Cockburn Health
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Visiting our hospitals
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Parking and transport
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Maps of Cockburn Health
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Visiting our hospitals
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Being a patient
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Understanding your surgical journey
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Your hospital admission
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Understanding where you will receive care
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During your hospital stay
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Ordering patient meals
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Elective surgery
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Outpatients
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Private patients
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Treatment costs for overseas visitors and students
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Going home from hospital
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Support during your stay
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Pastoral care
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Peer support workers
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Supporting Aboriginal patients and families
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Supporting people with disability
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Keeping you safe
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Reduce your risk of falls – Be SAFER
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Preventing pressure injuries
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About good hand hygiene
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Preventing healthcare associated infections
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Managing your health care
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Patient rights
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Goals of patient care
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Talk about 'What matters to you?'
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MySay healthcare survey
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Easy read resources
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For families and carers
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Pastoral care
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Supporting carers
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Supporting Aboriginal patients and families
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Supporting patients with cognitive impairment
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Understanding delirium
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If you can't visit an older patient
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The intensive care journey
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After the loss of a loved one
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Freedom of information
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Feedback compliments and complaints
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For health professionals
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Information for GPs
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SMHS GP Engage
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Refer a patient
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Service specific referrals
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Library and Information Service
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Our services
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Our community
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Volunteer with us
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Consumer Advisory Council
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'Put it to the People' engagement platform
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ED Consumer Advisory Group
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Mental Health Consumer Advisory Group (Fremantle Hospital)
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Pulse
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Our research
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Work with us
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Career opportunities
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Aboriginal workforce
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Allied Health
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Corporate non-clinical
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Graduates
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Medical
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Mental health
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Nursing and midwifery careers
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Fellowships
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Anaesthesia and Pain Medicine
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Medical Imaging Fellowships
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Living in WA
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News
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About us
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About FSFHG
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About South Metropolitan Health Service
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Feedback, compliments, concerns and complaints
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Conduct and standards
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Contact us
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Executive
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Our vision and values
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Our history
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Our Aboriginal heritage
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Forms
BIMS-EQ5D5L
BIMS-EQ5D5L
BIMS-EQ5D5L
The link you have used to access this questionnaire is incorrect
Under each heading below, please select the ONE box or answer that best describes your health TODAY.
UniqueCode
EQ5D5LSurvey
MOBILITY
I have no problems in walking about
I have slight problems in walking about
I have moderate problems in walking about
I have severe problems in walking about
I am unable to walk about
PERSONAL CARE
I have no problems washing or dressing myself
I have slight problems washing or dressing myself
I have moderate problems washing or dressing myself
I have severe problems washing or dressing myself
I am unable to wash or dress myself
USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities)
I have no problems doing my usual activities
I have slight problems doing my usual activities
I have moderate problems doing my usual activities
I have severe problems doing my usual activities
I am unable to do my usual activities
PAIN / DISCOMFORT
I have no pain or discomfort
I have slight pain or discomfort
I have moderate pain or discomfort
I have severe pain or discomfort
I have extreme pain or discomfort
ANXIETY / DEPRESSION
I am not anxious or depressed
I am slightly anxious or depressed
I am moderately anxious or depressed
I am severely anxious or depressed
I am extremely anxious or depressed
We would like to know how good or bad your health is TODAY.
This scale is numbered from 0 to 100.
100 means the
best
health you can imagine.
0 means the
worst
health you can imagine.
Mark an X on the scale to indicate how your health is TODAY.
Now, please write the number you marked on the scale in the box below.
YOUR HEALTH TODAY =
Last Updated:
23/01/2026